O4-1 A scoping study of the international implementation of the World Health Organisation's global physical activity action plan

Abstract Background Published in 2018, the World Health Organisation's Global Action Plan for Physical Activity (GAPPA) sets out 20 actions across 4 objectives (Active Societies, Active Environments, Active People, Active Systems) to reduce global inactivity by 15% by 2030. GAPPA takes a whole-systems approach (WSA), calling for cross-sectoral collaboration to address physical inactivity levels. This study sought to explore implementation to date, highlighting progress made and areas that require further focus. Methods A desk-based scoping study, using a systematic, but flexible approach, identified sites and personnel implementing GAPPA or a WSA. Methods of collection included a review of existing literature, snowball sampling of key individuals and internet searches. These methods identified a range of academics and practitioners who were subsequently contacted and interviewed on their use of GAPPA to date. Results Preliminary findings suggest that GAPPA's implementation currently varies greatly internationally. Some nations, including Finland and Scotland have embraced a WSA, taking steps to actively map their PA system. Elsewhere, countries such as Ireland and Australia are exploring practical approaches to implementing a WSA. GAPPA was only published in June 2018 and thus, where action is taking place, these countries offer important implementation evidence and opportunities for transferable learning. Regarding GAPPA's objectives, our review concludes that in nations that have embraced GAPPA, the Active Societies and Active Environments objectives are being actioned or have plans in development for action, while progress towards behaviour and system change objectives (Active People and Active Systems) appear less evident. Conclusions There is some promising evidence drawn from GAPPA's early implementation, although we conclude that if WHO targets are to be reached, wider adoption is needed. It appears that the nations who have best applied GAPPA, are those who arguably have pre-existing cross-sectoral networks in PA and public health. Therefore, perhaps a crucial first step in nationally implementing GAPPA is the establishment of these networks, laying foundations for collaborative action. Furthermore, the generation and dissemination of research by some of the early adopters is crucial to both reinforce knowledge transfer and guide others towards a whole-systems approach.


Background
Physical fitness outcomes are considered major health biomarkers to assess and monitor exercise-based interventions across the lifespan. Recent studies provide evidence that many adult and childhood chronic diseases should have their origins in gestational or fetal life. To date, a few pioneering studies have showed associations between prenatal predictors and selected physical fitness tests (strength and cardiorespiratory). Nevertheless, there is a lack of knowledge about the influence of prenatal factors on childhood performance on a comprehensive fitness test battery including speed and coordination. The innovative purpose of the current study is to analyse the relative weight of prenatal predictors on schoolchildren's physical fitness outcomes.

Methods
We obtain data from1188 children (571 girls) aged 6-11 years and 1020 adolescents (495 girls) aged 12-17 years. Prenatal predictors (gestational anemia, gestational diabetes and length of gestation) were self-reported from offspring's mothers. The ALPHA fitness test battery for youth was used to assess offsprinǵs physical fitness (muscular strength, motor fitness and cardiorespiratory fitness). Regression analysis were performed to predict the different physical fitness outcomes.

Results
The main findings of the present study indicate that the presence of gestational anemia significantly predicted lower scores of lower-body explosive muscular strength (standing long jump) and motor fitness (4x10-m shuttle run) and predicted moderately lower scores of upper-body isometric muscular strength (handgrip strength test). (p>.005; p>.008; p>.075 respectively). Moreover, gestational anemia better predicted lower scores of muscular strength and motor fitness in children than in adolescents (standing long jump, handgrip strength test, 4x10-m shuttle run) (p>.001; p>.051; p > 0.18, respectively). While gestational age and length of gestation (>34-?42 weeks) predict better cardiorespiratory fitness (20 m shuttle-run test) (p>.023; p>.023 respectively) and motor fitness (4x10 m shuttle; moderately for length of gestation). (p>.020; p > 0.55 respectively).

Conclusion
This evidence suggests that preventive strategies by health-care institutions, policy makers and technicians must be two-fold: a) to effectively reduce gestational anemia in order to prevent offsprinǵs predisposition to low levels of physical fitness, and b) to intervene with toddlers and children at risk to provide tailored physical activity programs and regular physical fitness evaluation.

Background
Published in 2018, the World Health Organisation's Global Action Plan for Physical Activity (GAPPA) sets out 20 actions across 4 objectives (Active Societies, Active Environments, Active People, Active Systems) to reduce global inactivity by 15% by 2030. GAPPA takes a whole-systems approach (WSA), calling for cross-sectoral collaboration to address physical inactivity levels. This study sought to explore implementation to date, highlighting progress made and areas that require further focus.

Methods
A desk-based scoping study, using a systematic, but flexible approach, identified sites and personnel implementing GAPPA or a WSA. Methods of collection included a review of existing literature, snowball sampling of key individuals and internet searches. These methods identified a range of academics and practitioners who were subsequently contacted and interviewed on their use of GAPPA to date. Results Preliminary findings suggest that GAPPA's implementation currently varies greatly internationally. Some nations, including Finland and Scotland have embraced a WSA, taking steps to actively map their PA system. Elsewhere, countries such as Ireland and Australia are exploring practical approaches to implementing a WSA. GAPPA was only published in June 2018 and thus, where action is taking place, these countries offer important implementation evidence and opportunities for transferable learning. Regarding GAPPA's objectives, our review concludes that in nations that have embraced GAPPA, the Active Societies and Active Environments objectives are being actioned or have plans in development for action, while progress towards behaviour and system change objectives (Active People and Active Systems) appear less evident.

Conclusions
There is some promising evidence drawn from GAPPA's early implementation, although we conclude that if WHO targets are to be reached, wider adoption is needed. It appears that the nations who have best applied GAPPA, are those who arguably have pre-existing cross-sectoral networks in PA and public health. Therefore, perhaps a crucial first step in nationally implementing GAPPA is the establishment of these networks, laying foundations for collaborative action. Furthermore, the generation and dissemination of research by some of the early adopters is crucial to both reinforce knowledge transfer and

Issue and problem
In Brazil, 47% of people are insufficiently physically active (Guthold et al, 2018). According to the Global Physical Activity Observatory, 13.2% of deaths in Brazil are caused by inactivity. Besides, Ding et al (2016) estimated the direct health cost attributable to physical inactivity in this country at 1.6 billion US dollars. Rio de Janeiro (RJ) is one of the largest cities in Brazil, with a high mortality rate (54.1%) from noncommunicable diseases (NCDs) and substantial health inequalities (SIM/MRJ, 2019). As a large city, it reproduces a worldwide trend, which associates economic growth and urbanization with an unhealthy lifestyle and epidemic levels of obesity and remarkable physical inactivity (WHO, 2014). Problem description The multifactorial context above described enables NCDs and challenges health protection systems. For this reason, the Municipal Health Department of RJ implemented since 2009 a Health-Enhancing Physical Activity (HEPA) policy: 'Programa Academia Carioca' (PAC). This policy supports regular physical activity free of charge, in Primary Care Health Units (UAP). The Program combines the practice of physical activity associated with various educational and community activities. It includes Physical Education professionals who work in a multidisciplinary way. Therefore, this study aims to evaluate the implementation of this policy. Results (effects/changes) After 11 years, the PAC has 142,969 participants, 80% of whom have NCDs. Among its participants, blood pressure control was demonstrated in 90% of hypertensive patients; weight loss, and a 60% reduction in cardiovascular risk classification, and suspension of medication in 20% of users. Being part of the PAC resulted in greater use and understanding of the general services of UAP in 86% and 98% of participants, respectively. Detailed results are not available at that time but will be presented at the conference.

Lessons
The PAC showed to be a successful tool to enhance health through physical activity at UAP. The use of trained and specialized professionals plays a fundamental key to develop educational and community actions in vulnerable groups.

Main messages
The implementation of an ambitious and integrated HEPA 1 2 Swansea, United Kingdom Corresponding author: Catherine.sharp@swansea.ac.uk Background Workplace physical activity interventions have shown positive outcomes for employee health, productivity and absenteeism (1,2). However, the majority prescribe the duration and/or type of activity to be undertaken. In response to strong public opinion that employers should do more to improve the health of their workforce, Public Health Wales, the public health agency for Wales, developed a 12-month pilot physical activity initiative -Time to Move (TTM). TTM allowed participants to use one hour/week (pro rata) of paid work time for any physical activity. We evaluated TTM to understand its impact and identify learning. Methods Using pre-experimental time series design, data were collected from participating employees: baseline (June-August 2018), mid-initiative (December 2018) and at 12-months (June-August 2019). Using validated scales where possible, questionnaires recorded: physical activity (MET-minutes/week), general health (0, poor-100, good), mental well-being (SWEMWBS), job satisfaction (1, very dissatisfied-5, very satisfied) and demographics. Biometric measures (baseline, 12months) included Body Mass Index (BMI) and blood pressure. Analyses used descriptive statistics, bivariate analysis and generalized linear modelling. Focus groups explored participants' perceptions of TTM, analysed thematically. Results 542 participants completed all measures (63.1% of baseline). Compared to baseline, at 12-months 57.7% reported increased physical activity (30.6% decreased; 11.6% no change) with 75.3% meeting UK activity guidelines (58.8% baseline). Those with the lowest levels of physical activity at baseline (n = 223) increased their weekly moderate activity by > 2.5 hours, whilst those with moderate activity (n = 269) increased by 58 minutes/week. A small improvement was reported in mental well-being (mean scores; 22.4 baseline, 23.2 12months), with participants with low mental well-being at baseline improving the most. Self-reported health and job satisfaction also improved. However, BMI and blood pressure changes were non-meaningful. Employee attitudes to TTM were positive. Organisational support was a motivating factor for participation, with competing demands a barrier.

Conclusions
The provision of paid time to engage in physical activity can improve employee health and well-being. TTM provides an